Rest Of sub-Saharan Africa Research Articles

Prevalence of Hypertension and Associated Factors among Patients Attending Hoima Regional Referral Hospital, Hoima District Western Uganda

Hypertension is an important contributor to the global burden of disease and mortality, and is a growing public concern in the developing world but data on hypertension and its associated factors among populations in the developing nations is minimal. However, in Uganda as the rest of Sub-Saharan Africa (SSA), emphasis has been placed on communicable diseases which are also highly prevalent in the region. This study assessed the prevalence of hypertension and its associated factors among adults twenty years and above attending Hoima Regional Referral Hospital. A cross-sectional study design was used. The study employed qualitative and quantitative research approaches to collect data. This study found a relatively high prevalence of hypertension (17.1%) among patients attending Hoima Regional Referral Hospital. The prevalence of hypertension in this peri-urban study area confirms the growing public health challenge of non-communicable diseases in Uganda. However, community-based studies are required to determine the extent of this problem and the associated factors of hypertension in Ugandan communities, owing to the increasing burden of NCDs in developing countries. We need interventions that aim to reduce the associated factors identified in this study, targeting the entire population to lower the risk and prevalence of hypertension. Keywords: Hypertension, Sub-Saharan Africa, Communicable diseases, cardiovascular diseases.

Epidemiological Study of Road Traffic Crashes in the Western Region of Cameroon

Background: Traumatic injuries resulting from road traffic crashes are a major cause of death and disability worldwide, with a global burden that is on the rise. In Cameroon like the rest of sub-Saharan Africa, more and accurate data on road traffic crashes outcomes and therapeutic care are needed to improve treatment and prevention. Objective: This study aims to determine the epidemiological features of the road traffic crashes in the western region of Cameroon. Methods: This study was a cross-sectional study which included all of individuals involved in road traffic crashes and admitted in health facilities located in and around the western road corridor the period from January 2019 to September 2023. International Classification of Diseases, Tenth Revision (ICD-10) was used as diagnostic criteria. Demographic variables, injury circumstances, hospital variables such as length of stay, time of admission, anatomical parts of injury according to Abbreviated Injury Scale (AIS) classification were derived from records. Results: Of total 812 crashes reported within the period of study, the victimology rate was 87.1% with various diagnoses: limb trauma without bone lesion (15.9%), fractures of one or more limbs (09.9%), multiple trauma (20.0%). Conclusion: Road traffic crashes cause enormous death and disability in this area and more road traffic preventive programs should be enforcement in these areas to reduce incidences road traffic crashes.

Economic impacts and management of fall armyworm (Spodoptera frugiperda) in smallholder agriculture: a panel data analysis for Ghana

BackgroundFall armyworm (Spodoptera frugiperda; FAW), a native pest of the Americas, invaded West Africa about 7 years ago and spread rapidly across the rest of sub-Saharan Africa (SSA) and several countries in Asia and Oceania. Early cross-sectional studies reported that the pest causes severe damage to maize, stimulating widespread use of synthetic pesticides in smallholder farming systems. Using panel data from Ghana, this paper assessed the impact of FAW on maize productivity and the changes in the strategies adopted by smallholder farmers for the management of the pest.MethodsHousehold data collected in two rounds (2018 and 2020) from 370 smallholder maize-growing households in Ghana were used. The dynamics of FAW infestation and the management practices applied by farmers were analysed descriptively, while panel data regression methods, such as fixed effects and correlated random effects models, were used to estimate the effect of FAW on maize productivity.ResultsWe found evidence of reduced intensity of pesticide use, increased use of protective equipment when spraying pesticides, increased adoption of biopesticides and cultural practices for FAW management, in line with recommended integrated pest management solutions. Results from panel data regression analysis showed that after controlling for other determinants of maize productivity and unobserved heterogeneity, the negative effect of FAW infestation on maize productivity is not statistically significant.ConclusionsOur findings suggest that with better knowledge of FAW and the use of more sustainable and environmentally-friendly solutions, the yield losses due to FAW are not as severe as initially reported.

Blood HBV DNA in newborns from HBsAg-positive mothers might be predictive of immunization response

Background: In Ivory Coast, as in the rest of sub Saharan Africa, despite the introduction of anti-hepatitis B vaccine, toddlers and children remain a segment of the population frequently infected with Hepatitis B Virus (HBV). The conditions of early HBV transmission, and notably the materno-fetal route remain summarily documented in sub Saharan Africa. Methods: From June to November 2018, we analyzed the socio-demographical, serological, and viral features related to HBV transmission in expectant mothers and their newborns who came for delivery at the CHU Cocody Abidjan. Results: Out of 1628 contacted expectant mothers, a subset of 508 accepted to participate to the study, including 163 who were positive for HBsAg. All 56 mothers who transmitted either HBsAg or HBV DNA to their babies were presenting HBV DNA loads >5.0 log10 IU/mL Remarkably, fates of newborns either positive for HBsAg or HBV DNA who completed immune-prophylaxis were drastically different at 9-12 months. While a majority (90%) of HBsAg (+)-only babies became anti-HBs (+), 62.5% DNA-positive newborns failed to mount a proper anti-HBs response. Overall, 10.7% of newborns with at least one positive HBV marker at birth develop a bona fide chronic infection at 9 months. Conclusions: In Ivory Coast, pregnant women presenting HBV DNA loads above 5.0Log10 IU/mL are at risk of maternofetal transmission. Presence of HBV DNA in the blood of newborns represents a better predictor of anti-HBV immunization failure than HBsAg presence. An adaptation of immunization procedures with a passive immune prophylaxis targeting specifically newborns at risk should be urgently considered.

Risky Sexual Behavior and Associated Factors among Youth in Kakamega and Kericho Counties, Kenya

Introduction: HIV remains the most significant public health and developmental challenge in the world. In Kenya, just like the rest of sub-Saharan Africa, young people aged 15-24 years bear the biggest brunt of the HIV epidemic. Lack of comprehensive knowledge of HIV prevention, low condom use, low uptake of HIV services and having multiple sexual partners, have been associated with these trends. This study set out to determine risky sexual behaviour and associated factors among youth in Kakamega and Kericho Counties in Kenya.
 Methodology: To achieve this, a cross-sectional survey was conducted among youth in Kakamega and Kericho counties, Kenya. Consenting young people residing in these counties were the study subjects. Data was collected through structured interviews with young people using a standard questionnaire and direct observation. The qualitative data were transcribed, translated and entered into NVivo software for coding and further analysis. The quantitative data were entered into SPSS for descriptive and inferential analysis.
 Results: Despite the youths in both counties having high comprehensive knowledge of HIV prevention at 79.3%, they still engaged in risky sexual behaviours and 60.6% were in a sexual relationship. The uptake of HIV testing was 58.4% with an HIV prevalence of 6.9%. Condom use was only 48.1% and both males and females did not reveal irritation in the genital area to partners χ2 - test showing (P > 0.05).
 Conclusion: The results of this study will inform the design of an HIV prevention information package that will promote safer sexual behaviour among young people.

Outcomes of second-line antiretroviral therapy among children living with HIV: a global cohort analysis.

IntroductionLimited data describe outcomes on second‐line antiretroviral therapy (ART) among children globally. Our objective was to contribute data on outcomes among children living with HIV after initiation of second‐line ART in the context of routine care within a large global cohort collaboration.MethodsPatient‐level data from 1993 through 2015 from 11 paediatric HIV cohorts were pooled. Characteristics at switch and through two years of follow‐up were summarized for children who switched to second‐line ART after starting a standard first‐line regimen in North America, Latin America, Europe, Asia, Southern Africa (South Africa & Botswana) and the rest of sub‐Saharan Africa (SSA). Cumulative incidences of mortality and loss to follow‐up (LTFU) were estimated using a competing risks framework.ResultsOf the 85,389 children on first‐line ART, 3,555 (4%) switched to second‐line after a median of 2.8 years on ART (IQR: 1.6, 4.7); 69% were from Southern Africa or SSA and 86% of second‐line regimens were protease inhibitor‐based. At switch, median age was 8.4 years and 50% had a prior AIDS diagnosis. Median follow‐up after switch to second‐line ranged from 1.8 years in SSA to 5.3 years in North America. Median CD4 counts at switch to second‐line ranged from 235 cells/mm3 in SSA to 828 cells/mm3 in North America. Improvements in CD4 counts were observed over two years of follow‐up, particularly in regions with lower CD4 counts at second‐line switch. Improvements in weight‐for‐age z‐scores were not observed during follow‐up. Cumulative incidence of LTFU at two years was <5% in all regions except SSA (7.1%) and Southern Africa (7.4%). Risk of mortality was <3% at two years of follow‐up in all regions, except Latin America (4.9%) and SSA (5.5%).ConclusionsChildren switched to second‐line ART experience CD4 count increases as well as low to moderate rates of LTFU and mortality within two years after switch. Severe immune deficiency at time of switch in some settings suggests need for improved recognition and management of treatment failure in children.

A comparison of integrated pest management and traditional practices for bagged maize stored in Nigeria

In grain markets in Nigeria, stored product insects can cause significant losses in quality and quantity of stored grains. Insect infestations in storehouses are usually controlled by the unilateral use of chemical insecticides, which have unintended adverse effects. In this study, approximately 15 MT of well-dried, Aflasafe™-treated maize was procured from a local farm settlement in January 2016. It was subsequently fumigated, mechanically cleaned and placed in 100-kg polypropylene bags for storage. The study was conducted during February–December 2016, to compare the effectiveness of traditional storage practice (TSP) with integrated pest management (IPM) practice. IPM for warehouse facilities focuses on adequate drying, inspection and cleaning of storehouses and their surroundings and regular examination of grain (IPMD). Traditional storage practice generally has little or no sanitation of the facility or regular examination of grain (monitoring) for insect pests. Study locations were markets in Ibadan, Oyo and Ilorin towns in Southwest and Northcentral Nigeria, respectively. Each market had two storehouses where TSP or IPMD was assigned; each storehouse had twenty-five bags of maize, which were sampled monthly to assess the effects of the two practices on stored maize insect populations and quality. Generally, from October to December, there tended to be more insects of all species in TSP than IPMD. Percent insect damaged kernels (%IDKNB) and weight loss (%WL) were also higher in TSP than IPMD during the October–December period. Percent germination in December was higher in IPMD (96.3%) than in TSP (85.3%). Aflatoxin levels in both TSP and IPMD did not exceed 1.9 ppb. Data from this study show that IPMD results in lower stored-product insect population levels and better maize quality than TSP. Thus, IPMD practice needs to be more widely adopted in storehouses in Nigeria and the rest of sub-Saharan Africa.

Prevalence of HIV Infection among Adolescents and Young People at a Tertiary Health Facility in Ekiti State, Southwest, Nigeria

Background: Nine out of every 10 of the world’s 1.8 billion adolescents and young people (AYP) live in developing nations, Nigeria inclusive. In Nigeria as in the rest of sub-Saharan Africa, 1 out of every 3 persons is an adolescent or a young person. As at 2016, there were about 240, 000 AY) aged 10-19 years in Nigeria, which roughly makes 7% of the total number of people living with HIV (PLWH) in Nigeria. According to 2017 national survey, about 70% of the country’s AYP lack knowledge of how HIV is transmitted or how it can be prevented. Since AYP, aged 10-19 years, constitute a significant proportion of the nation’s burgeoning population, it is very important and critical to fully understand the dynamics of the HIV epidemic among AYP. This study aimed at determining the prevalence of HIV among AYP at a tertiary health facility in Ekiti State, Southwest Nigeria and comparing it with national and regional prevalence among same group.&#x0D; Methodology: The study was a retrospective study of AYP, aged 13-20 years at Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Southwest Nigeria. Convenience and consecutive sampling method was used in retrieving subjects’ data. One hundred subjects whose ages were between 13 and 20 years were consecutively sampled over a period of six months, July to December, 2018.&#x0D; Results: Out of the one hundred subjects retrospectively sampled, 46 (46%) were males, while 54 (54%) were females. Four (4%) of the subjects were 13 years of age, while 6(6%), 5(5%), 8(8%), 27(27%), 17(17%), 12(12%) and 21(21%) respectively were aged 14, 15, 16, 17, 18, 19 and 20 years. Three (3%) of the subjects were positive to HIV, 1 (%) was male, while 2 (20%) were female, thus giving a sero-prevalence rate of 3%. Disaggregation of the positive subjects reveals that 33.3% were male, while 66.7% were females.&#x0D; Conclusion: Though the general prevalence of HIV in Ekiti State ranks among the lowest in Nigeria, group-specific interventions targeting the AYP should be put in place in the State to address the disproportionately high prevalence among the AYP in the State.

Imported malaria cases: the connection with the European ex-colonies

BackgroundImported malaria is increasing in non-endemic areas due to the increment of international travels, migration and, probably, other unknown factors. The objective of this study was to describe the epidemiological and clinical characteristics of malaria cases in a region of Spain; analyse the possible association between the variables of interest; compare this series with others; and evaluate the characteristics of imported malaria cases according to the country of origin, particularly cases from Equatorial Guinea (Spanish ex-colony) and from the rest of sub-Saharan Africa.MethodsA descriptive observational study was carried out with a retrospective data collection of cases of malaria reported in Aragon from 1996 to 2017. Univariate and bivariate analysis of clinical–epidemiological variables was performed. In addition, an analysis of cases from sub-Saharan Africa was carried out using logistic regression, calculating odds ratio with its 95% confidence interval.Results609 cases of malaria were recorded in Aragon from 1996 to 2017. An autochthonous case in 2010. 50.33% were between 15 and 39 years old. 45.65% of the cases were notified of the 4-weeks 9 to 12. 82.6% reside in the main province, urban area, of which 65.4% were VFR (Visiting Friends and Relatives), 23.8% new immigrants and 10.9% travellers. The infectious Plasmodium species par excellence was Plasmodium falciparum (88%). Analysing the cases from sub-Saharan Africa (95.2% of the total), 48.1% were from Equatorial Guinea. Comparing these with the cases from the rest of sub-Saharan Africa, it was observed that the cases from the Spanish ex-colony have association with the female gender, being under 5 years old, residing in the main province (urban area) and being a new immigrant.ConclusionsThe epidemiological profile of imported malaria cases can be defined as VFR between 15 and 39 years old, coming from sub-Saharan Africa, particularly from Equatorial Guinea. Immigrants education about the importance of chemoprophylaxis when travelling to visit friends and relatives, emphasizing on those who are originally from the ex-colonies of destination country, is necessary; as well as to raise awareness among health professionals to make advice in consultations, specially before summer vacations.

Cervical cancer screening opportunities for Guinea-Bissau

Guinea-Bissau is a severely resource constrained country, in search of political stability and development in every sector of public life. International aid is permanent and healthcare is one of the most targeted fields, focusing mostly on infectious diseases, maternity, infant malnutrition, access to healthcare and gender inequality in health. As in the rest of Sub-Saharan Africa, cervical cancer is gathering increasing attention from the community and ruling officers. The potential of screening for control of cervical cancer raised the interest of adapting screening methods to low-resource settings. This started the search for the best resource-adapted strategies, which promoted several trials that currently shape the development of screening programs in these countries. Prevention and control strategies are also being adapted taking into account the availability of human Papillomavirus vaccination. Nonetheless, several barriers are still in place for widespread vaccination programs, and cervical cancer screening and treatment remain central in the control of cervical cancer in low-resource settings.We intend to discuss current cervical cancer screening approaches in low-resource countries and opportunities for their implementation in Guinea-Bissau.

Blood transfusion safety; current status and challenges in Nigeria.

The attainment of blood transfusion safety in Nigeria (and probably the rest of Sub-Saharan Africa) remains an uphill task due to a number of factors, ranging from shortage of blood, poor implementation of blood transfusion guidelines, infrastructural deficits to high prevalence of transfusion-transmissible infections (TTIs), particularly hepatitis and human immune deficiency viruses. We reviewed available data on blood transfusion practices and safety in Nigeria using the PubMed, PubMed Central, Google Scholar, and African Index Medicus search engines, through a combination of word and phrases relevant to the subject. The World Health Organization has been in the forefront of efforts to establish safe, available, and affordable blood transfusion services in most parts of Africa through encouraging adequate blood donor recruitment, donor blood testing, and collection as well developing strategies for the rational use of blood. Even though modest improvement has been recorded, particularly with regards to donor blood screening for common TTIs, considerable efforts are needed in the form of robust public enlightenment campaigns (on blood donation) and continuous system improvement to drive the current transfusion practices in the country toward safety and self-sustenance.

The South African Renewable Energy Independent Power Producer Procurement Programme: A Review and Lessons Learned

The South African Renewable Energy Independent Power Producer Procurement Programme (REIPPPP) is a competitive tender process that was launched to facilitate private sector investment into grid-connected renewable energy (RE) generation. It has been an undisputed success in terms of capacity, investment and price outcomes. Since 2011 a total of 6,328 Megawatts of wind, solar PV and other RE generation capacity has been procured, amounting to USD 20.5 billion in investment. Bid tariffs have fallen sharply over the course of the programme and the most recently awarded projects are amongst the lowest priced grid-connected RE projects in the world. Considering South Africa's success in achieving more investment via Independent Power Producers (IPPs) in 4 years than in the rest of Sub-Saharan Africa over the past 25, the REIPPPP's design and management is likely to be of interest to policymakers in African (and other developing) countries. This paper thus provides a comprehensive review of the programme’s tender documentation, implementation, and outcomes to date. Together with supporting research, this analysis has been used to develop a set of high-level lessons intended to facilitate the roll out of similar RE IPP competitive tender programmes in other emerging markets.

Disease Severity Scores and Haemogram Parameters in Nigerian Sickle Cell Disease Patients

Background: Sickle cell disease (SCD) is associated with high mortality in Nigeria and the rest of sub-Saharan Africa; there is need to find easily available parameters that could predict disease severity and influence therapy. Objective: To evaluate the haemogram of a population of SCD patients and correlate these with objective scores of disease severity. Methods: Sixty (60) asymptomatic steady state (ASS) SCD patients in our clinic were randomly selected and interviewed with a questionnaire. Their haemogram was done using a 17 parameter, 3-part white cell differential, auto-analyser (KX 21N, Sysmex corporation, Chuo ku, Kobe, Japan) and objective severity scores calculated using a modification of the method proposed by Anyeagbu et al. Statistical analysis of data was done using Statistical Package for Social Sciences software, version 20 (SPSS Inc., IL, Chicago, USA), with significance assigned to p values less than 0.05. Result: Of the 60 subjects assessed, severity scores were calculated for 49: 11 (22.4%), 31 (63.3%) and 7 (14.3%) met the criteria for mild, moderate and severe disease respectively. The haemogram parameters that were significantly correlated with disease severity were mean corpuscular haemoglobin concentration (MCHC), and white blood cell count (WBC), p=0.014, and 0.001 respectively. Haemoglobin concentration (Hb) and packed cell volume (PCV) were negatively correlated with disease severity (p=0.001). Conclusion: In addition to already known haemogram parameters that affect SCD severity (such as WBC, Hb concentration, and PCV) MCHC also does same and can be manipulated by drugs and other kinds of therapy to ameliorate severity in patients.

The Economic Impacts of Climate Change on Agriculture in Africa

The African continent is projected to suffer adverse impacts from climate change, which are disproportionate to its contribution to global carbon dioxide emissions. Africa is particularly vulnerable because it is among the hottest places on the Earth and therefore any further warming will likely have adverse socioeconomic consequences; and most of the economies in this region rely mainly on natural resources and rain-fed agriculture, which are very sensitive to climate change and variability. This article investigates the impacts of climate change on African agriculture and discusses the policy implications for managing these impacts. The modelling results show that Africa will experience the largest impacts from climate change in terms of decline in economic growth and welfare losses. The disaggregated results show that Southern Africa will be the hardest hit region, followed by the Rest of sub-Saharan Africa, North Africa and East Africa, in that order. There is therefore need for concerted efforts at adaptation, which should include introduction of temperature-sensitive varieties, diversification of production systems and livelihoods, shift to sustainable agricultural intensification, shift to irrigation agriculture, addressing institutional challenges such as poor physical and social infrastructure, market imperfections, lack of access to credit, and lack of crop insurance, etc. In the long run, emphasis should be placed on diversifying away from agriculture to industry and services.

Road traffic injuries in Yaoundé, Cameroon: A hospital-based pilot surveillance study

BackgroundRoad traffic injuries (RTIs) are a major cause of death and disability worldwide. In Cameroon, like the rest of sub-Saharan Africa, more data on RTI patterns and outcomes are needed to improve treatment and prevention. This study analyses RTIs seen in the emergency room of the busiest trauma centre in Yaoundé, Cameroon. MethodsA prospective injury surveillance study was conducted in the emergency room of the Central Hospital of Yaoundé from April 15 to October 15, 2009. RTI patterns and relationships among demographic variables, road collision characteristics, injury severity, and outcomes were identified. ResultsA total of 1686 RTI victims were enrolled. The mean age was 31 years, and 73% were male. Eighty-eight percent of road collisions occurred on paved roads. The most common user categories were ‘pedestrian’ (34%) and ‘motorcyclist’ (29%). Pedestrians were more likely to be female (p<0.001), while motorcyclists were more likely to be male (p<0.001). Injuries most commonly involved the pelvis and extremities (43%). Motorcyclists were more likely than other road users to have serious injuries (RR=1.45; 95% CI: 1.25, 1.68). RTI victims of lower economic status were more likely to die than those of higher economic status. DiscussionVulnerable road users represent the majority of RTI victims in this surveillance study. The burden of RTI on hospitals in Cameroon is high and likely to increase. Data on RTI victims who present to trauma centres in low- and middle-income countries are essential to improving treatment and prevention.

Medical laboratories in sub-Saharan Africa that meet international quality standards.

A recent survey of laboratories in Kampala, Uganda, demonstrated that only 0.3% of laboratories (3/954) met international quality standards. To benchmark laboratory quality throughout the rest of sub-Saharan Africa (SSA), we compiled a list of SSA laboratories meeting international quality standards. Accrediting bodies were queried via online registries or direct communication in May 2013. There were 380 laboratories accredited to international standards in SSA. Ninety-one percent were in South Africa. Thirty-seven of 49 countries had no laboratories accredited to international quality standards. Accredited laboratory density (per million people) in South Africa, Namibia, and Botswana were similar to those in many European countries. Single variable linear regression showed a correlation between accredited laboratory density and health expenditures per person (adjusted R(2) = 0.81, P < .001). Most SSA countries do not have an accredited clinical laboratory. For those that do, there is a strong correlation between country-specific accredited laboratory density and per-capita health expenditures.

Bigotry and Oppressive Laws in Africa Drive HIV in Men Who Have Sex with Men

The study in this week’s issue of PLOS Medicine by Jewkes and colleagues on the prevalence of consensual male-male sexual activity and non-consensual male-on-male sexual violence, and their respective associations with HIV infection in South Africa [1], makes an important contribution to the dearth of literature on population-based HIV prevalence amongst men who have sex with men (MSM) in the African context. The paper highlights several important findings, including that HIV prevalence amongst South African MSM also has public health implications for South African women, given high levels of bisexuality and sexual concurrency amongst South African MSM. Assuming these findings are generalizable to the rest of sub-Saharan Africa, addressing the health needs of African MSM will require policymakers to meaningfully address significant socio-cultural and legal barriers that hinder access by MSM to HIVrelated health services. Failing to do so will fuel the spread of HIV in African men who engage in consensual male-male sexual activity and/or who are victims of male-on-male sexual violence. Socio-Cultural Barriers

Telerehabilitation in South Africa - is there a way forward?

South Africa, like the rest of sub-Saharan Africa, has a disproportionate burden of disease and a shortage of health professionals. Telemedicine has been identified as a possible way of overcoming part of the problem but telemedicine has not been widely adopted. In the public sector hospitals in South Africa which serve 82% of the population there are 2.5 physiotherapists and 2 occupational therapists per 100,000 people served. The extent of telerehabilitation in South Africa is unknown. A literature review of telerehabilitation found no papers from South Africa. A survey of the heads of university departments of physiotherapy, occupational therapy and speech and language pathology revealed limited knowledge of telerehabilitation. Telerehabilitation services are confined to follow-up of patients at some institutions by telephone, fax or email. There is need to raise awareness among therapists if telerehabilitation is to become a reality in South Africa. Future actions are outlined.

The Recent Election and the Zuma Presidency

This article takes stock of the achievements and the shortcomings of post-apartheid South Africa, notably under the stewardship of Presidents Nelson Mandela and Thabo Mbeki. It analyses the implications of the General Elections held in April 2009 and offers some insights into the likely direction that a government headed by President Jacob Zuma will take over the coming months. The author argues, among other things, that the next five years will be crucial to the consolidation and promotion of constitutional democracy in South Africa, which in turn will determine the political future of the rest of sub-Saharan Africa.

GM Cotton for Africa

Cotton is the most important cash crop for smallholders in many countries of Sub-Saharan Africa (SSA). Although GM cotton has been grown in South Africa for more than 10 years, most of the other SSA countries are only now enacting the biosafety legislation, with the supporting biotechnology policy, to enable them to acquire GM cotton technology from the biotechnology companies that hold the intellectual property rights. Burkina Faso, now the largest cotton producer in SSA, will be the first to make GM cotton available to smallholders. GM cotton is being promoted in the rest of SSA on the basis of its apparent success in improving the profitability of cotton growing as a smallholder enterprise in South Africa, India and China. With several other African countries soon to follow Burkina Faso in adopting GM cotton technology, this paper examines the potential benefits for Africa in the light of evidence from smallholder adoption elsewhere in the world.